Infection control
engagement - meaning that the number of staff entering and exiting the cottages was minimised. HammondCare’s early adoption of the ‘Partnering in care’ initiative allowed family members to be trained in infection control and to be allowed to visit even during lockdowns. This programme resulted in no transmissions of the virus. HammondCare also operates several homes which are acquired buildings, and are of an older, larger-scale nursing model type. Larger numbers of people live together, food is prepared centrally, and staff move between different areas more freely.
Michael Cooney, head of residential services at HammondCare, notes that there was a stark difference between this type of building and the cottage-style in terms of infection outcomes: “Where we were getting cases, the large outbreaks were at our institutional settings. The biggest impact related to deaths – we had no deaths in our cottage environments (though our death rate was low generally). Environment is absolutely the key. Our experience was that when there was an outbreak, it was contained within that cottage. However, in the institutional settings there was wider spread of infection through all parts of the building.”
HammondCare Wahroonga, a multilevel purpose-built home split into six discrete 9 and 12 place apartments, was one of the least affected of HammondCare’s homes. Despite not being a typical
The cottage design strives to be as home-like as possible, with residential detailing, carpet throughout, and residents encouraged to bring their own furniture and personal items
‘cottage’ environment, the same design and operational principles apply; these are small, self-contained households with multi-skilled staff allocated to individual households, with good access to outdoor spaces. HammondCare Wahroonga recorded only two cases of COVID-19 in the latest wave (Omicron 2021/22).
Global results These low results were not unique to HammondCare. In the US, The Green House Project, which promotes a small household model with multi-skilled staff, also reported fewer cases and deaths. According to Dr David Grabowski, professor of health care policy at Harvard medical school: “Everything about the Green House model allowed it to fare better during COVID. The small home aspect (we know that larger homes were hit much harder). Fewer staff coming in and out of the building. Beyond that, the consistent assignment and better pay for staff is also going to help protect them and residents feel more engaged, (be) less isolated, and all of those are going to allow residents to thrive better in a pandemic.”
These stories correlate with a recent study of factors associated with SARS-
COV-2 attack rates in aged care – a meta- analysis carried out by Kunasekaran et al. (Feb 2022)7
which found that infection
rates in residents were significantly higher in ‘single-site facilities’ with standalone buildings than facilities with ‘smaller, detached buildings’. Their conclusion was that ‘the design of aged care facilities should have smaller-sized facilities with adequate space for social distancing.’ They also noted that over-crowding, the sharing of bathroom facilities, and difficulties in social distancing were associated with the potential for high transmission rates in aged care homes.
Designing for pandemic preparedness It is perhaps easy to see a correlation between an environment of discrete households and a reduced number of infections, but was there also something subtler at play? Tom Grey (2021) and colleagues argued in their paper Nursing Home Design and Covid 19: Balancing Infection Control, Quality of Life and Resilience that ‘a prospective approach to improving quality of life, which includes maintaining connection to others and an overall focus on health and general wellbeing, is a critical part of pandemic preparedness as it strengthens resilience.’ Julie Christie (2020) described resilience as ‘the process of adaptation in the face of adversity’ and is influenced by a person’s ‘protective factors,’ including: n their sense of connectedness with others;
n their sense of mastery and control; and
n their meaning-making opportunities.8
Figure 1. Dementia-specific aged care home divided into separate apartments, each with large terraces (HammondCare Wahroonga, Sydney)
28
It is interesting to note the alignment of these protective factors with what the research suggests are aspects which contribute to a sense of ‘home’ for residents in aged care. These are social, psychological, and environmental aspects: n Social aspects (connectedness with others) include having symmetric interaction with staff, interaction with residents, family, friends and pets, and meaningful activities.
n Psychological aspects (including
www.thecarehomeenvironment.com June 2022
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